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DATE RECEIVED � tt,, <br /> � � SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> �, ' �� ENVIRONMENTAL HEALTH DEPARTMENT <br /> / 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Tele ne: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: liames Helge BUSINESS/AGENCY: ENERCON Services <br /> ADDRESS: 3434 Marconi Ave Sacramento, CA 95821 CITY/STATE/ZIP: <br /> PHONE (1): 916-480-9228 PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$1?6 FEE(CASH OR CHECpK O�NLY)-R VEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 5 . kL G ht�t DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City - ❑ Unit 1 <br /> 1. 11055 South Stockton Blvd r`sF Stockton <br /> 2' 1137 S. StocktJStockton ❑ Unit z <br /> s. <br /> 4. Uni <br /> `° ta . <br /> 5. e <br /> � <br /> 6. &A Unit 4 <br /> 7. <br /> 8. ❑ Unit5 <br /> 9. <br /> 10. ❑ Units <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �y UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY E]DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At_least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. **'BOXED AREA-EHD USE ONLY <br /> ❑ Records provided by Staff-PPR Complete, Staff Name: <br /> EHD 48-06 914112 <br />